They're Here: The 2020 CMS Model Materials
By Toppan Merrill
1 min read | Industry Insights Insights Home

2020 CMS Model docs

Toppan Merrill’s MCS team has been diligently working on system updates for our clients since the day CMS’ 2020 model materials arrived, on May 24th, 2019.   We’re excited about the model updates for a few reasons...

Compared to last year’s changes of approximately 280 per EOC, this year CMS surprised us with an average of only 70 changes, which means about 75% fewer hairpin turns for the industry.  The ANOC models revealed approximately 30 changes.

We’re even happier about MCS’ position with these content updates:  The enhancements to our platform year-over-year have enabled this year’s EOC and ANOC updates to be implemented a full three weeks ahead of our normal schedule.   The timing and methodology has significantly carved-out the amount of content customization needed for first-round delivery to clients, and places us at an even better vantage point this year to brave CMS’ inevitable model updates with greater ease.

Some of the changes we’re most excited about, are CMS’ introduction of two new benefits offered to plan members: “Opioid Treatment Program Services,” and, “Special Supplemental Benefits for the Chronically Ill.”  Trends in beneficiary needs are acknowledged through these benefit offerings for those stricken with opioid addiction or sensitivities, and those needing special considerations within their benefits for dealing with the nuances of chronic illness while not necessarily needing the full benefits design of a Chronic Special Needs Plan (C-SNP). 

CMS has long been involved with monitoring and enforcement related to the opioid epidemic, and now provides coverage for the new benefit under Medicare Part B.  Plans may provide additional services under this benefit such as toxicology testing and individual and group therapies.  We’re confident more information is coming soon, but so far the benefits for Opioid Treatment Program Services appear to be separate from those under the Outpatient Substance Abuse Services.  As another enhanced member option, plans can choose to offer “Special Supplemental Benefits for the Chronically Ill.”  The benefit must be proposed during the plan’s bid submission including which health conditions apply, and what the enrollee’s medical criteria must be to qualify (this might be diabetes, or other chronic conditions). 

CMS loaded the 2020 models with clarifying language which we hope will minimize the number of models re-released by CMS for this year.  We’re anticipating at least one revision, as CMS has already asked plans their opinion on updating required content to include/disclose a complete list of Part B drugs that are subject to step therapy requirements – and is inviting further ideas on any related topics.  We’re in favor of anything supportive to Medicare beneficiaries, yet hopeful CMS will go easy on us all this year and minimize at least the number of model revisions.

To see CMS’ 2020 model documents, please go to the zip file provided at these following inks for MA models, and Part D models respectively: 

https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMaterial.html

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Part-D-Model-Materials.html

Contact us today to find out how we can take the burden out of managing your ANOC/EOC documents.

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Toppan Merrill


Toppan Merrill, a leader in financial printing and communication solutions, is part of the Toppan Printing Co., Ltd., the world's leading printing group, headquartered in Tokyo with approximately US$14 billion in annual sales. Toppan Merrill has been a pioneer and trusted partner to the financial, legal and corporate communities for five decades, providing secure, innovative solutions to complex content and communications requirements. Through proactive partnerships, unparalleled expertise, continuous innovation and unmatched service, Toppan Merrill delivers a hassle-free experience for mission-critical content for capital markets transactions, financial reporting and regulatory disclosure filings, and marketing and communications solutions for regulated and non-regulated industries. With global expertise in major capital markets, Toppan Merrill delivers unmatched service around the world.


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